Facility Evaluation Report

Licensing Program Analysts (LPAs) Kathrina Chin and Beverly Thompson-Gracia conducted an unannounced required annual inspection in this facility. LPA met with Shella Manalang, Administrator and stated the purpose of this visit.

The facility is a single structure and licensed for 2 non-ambulatory.

LPAs was granted entry after completing the COVID-19 screening procedure. Facility had four residents in care and four staff members on the floor. LPAs toured the interior and exterior portions of the facility. There were four private rooms. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke, carbon monoxide and auditory exit alarms were tested to be operational. Bathrooms were observed to be in good repair; and provided with grab bars and non-skid floor mats. Hot water was measured at 114.6 degrees Fahrenheit. Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to residents in care. Fire extinguisher was mounted and charged. For the exterior portion, facility had patio furniture in good repair, and grounds were free of tripping hazards. Side exit door was self-closing and self-latching.

LPAs reviewed the COVID 19 mitigation plan of the facility. The facility has sufficient PPE supplies.

For this review, the facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations.

LPA Chin conducted an exit interview with Shella Manalang, AD; and copy of this report was left in the facility.